1. What cause flexion injuries?
    When the head is jolted fowardin a head-on collision from deceleration. 
  2. How can hyperextension injuries occur?
    When forces are applied to the forehead or face. Tearing of supporting ligaments 
  3. Where do C3 to C5 innervate?
    The diaphragm
  4. Where does T2 to T8 innervate?
    intercostal muscles 
  5. Where does T8-T12 innervate?
    The abdominal muscles
  6. What happens if the spinal injury is at the level of C3?
    all of the muscles of respiration are paralyzed and no spontaneous respirations occur
  7. What happens if injuries occur at or above C5?
    result in loss of both the intercostal and the abdominal muscles of breathing, resulting in diaphragmatic breathing only. Smaller tidal volumes of air, may note only abdominal movement only, unable to cough effectively and more diffculty clearing secretions,  blood, and vomitus. 
  8. What happens to the blood pressure with a spinal injury at or above the upper thoracic level?
    Patient may become hypotensive from vasodilation. With the lack of sympathetic nervers to control the  tone of the blood vessels, blood vessels dialte and blood pressure falls (hypotension). 
  9. What do many patients with neurogenic shock present with?
    They usually have systolic blood pressure levels in the range of 70 to 80 mm Hg. Their pulse rate appears normal in the range of 60 to 80 beats per minute. Vessels are dilated, the skin may be warm and perhaps flushed. 
  10. Why don't spinal cord injury patients have normal signs of shock such as rapid pulse or clammy skin?
    loss of sympathetic functions
  11. Piapism
    another sign of spine injury
  12. What would you do first open the airway or stablize the spine?
    open the airway
  13. Tell me the difference between structral injury and metabolic injury
    Structral injury patients present with injury to one side of the body and it doesn't affect the other side of the body. Metabloic injuies on the other hand will effect the whole CNS. For an example someone who ate rat posioning will not just effect one side of the body it will affect both sides.
  14. What are secondary complications of direct injury to the brain?
    hypoxia, hypotension, hypoglycemia, infections, and increased intracranial pressure (ICP)
  15. What is normal satruation for pulse oximetry?
    95% to 100%
  16. What does the Brain Trauma Foundation recomend treatment to keep oxygen saturation greater than what to prevent hypoxia?
  17. How does a spinal injury cause hypotension?
    widespread of vasodilation
  18. What does hypotension present as?
    rapid pulse, cool, pale, clammy skin
  19. How can hypoclycemia cause a spinal injury?
    A patient was working on their roof missed a meal, became faint and fell through the roof. If brain damage occurs from the fall, the chance of healing is futher compromised by the lack of a vital brain nutrient, glucose. 
  20. How is intercranial pressure related to spinal injuries?
    the patient may have experienced a head injury then recovered. Then later experienced deterioration in mental status. 
  21. Can a patient bleed from a scalp laceration? 
  22. What are symptoms of intracrainal pressure of a conscious patient?
    They may complain of headaches, nausea, and vomting.
  23. What are symptons of ICP when the patient begins to deteriorate?
    the level of consciousness begins to deteriorate, sleepy, more confused, difficult to arouse, only respond to painful stimuli.
  24. Who experiences drowsiness, nausea, and vomiting even after a minor injury?
  25. What happens to the eyes when ICP increases.
    The brain is forced down into the foramen magnum. Eye findings may include a dialted pupil on one side. The dialated pupil may not constrict when a light shines in it. The eyelid over the dilated pupil may droop. The patient may also have one sided weakness 
  26. What happens with Really bad ICP?
    The patient may assume abnormal body positions or postures. (decorticate posturing) and (decerebrate posturing) Increased blood pressure with a slow pulse
  27. Decorticate Posturing
    in which the arms are flexed but the legs are extended
  28. Decerebrate Posturing
    in which the arms are extended and internally rotated at the shoulders, with the wrists flexed and the legs extented. 
  29. The final stages of ICP
    the limbs flaccid and the muscles limp without tone
  30. What causes epidural hematoma?
    A blunt blow to the head. 
  31. What do epidural hematomas present with?
    Short period of unconsciousness, followed by lucid interval during which the patient regains consciousness. Shortly after the patient shows a decrease or alteration in the level of consciousness and has a dilated pupil on the side of the blow and weakness and sensory impairment on the opposite side of the body. Then abnormal respirtory patterens, posturing, possibly high blood pressure, slow pulse then death if not treated
  32. Where do epidrual hematomas occur?
    in the space between the dura and the skull resulting from arterial bleeding
  33. Where do subdural hematomas occur?
    in the space between the dura and the arachnoid and result from venous bleeding
  34. Who is at an increased risk for a subdural hematoma?
    Geriatric patients because they are prone to falls and they size of their brain shrinks. may take several days to present
  35. What is a contrecoup injury?
    When the head gets in a dynamic injury in which the brain gets hit on one side then it moves all around and hits the other side of the skull.
  36. Glassgow Comma Scale
    Eyes: do not open=1, Open to painful stimuli=2, Open to voice=3, Open spontaneously= 4

    Verbal: makes no sound=1,  Incomprehensible sounds=2, Utters inappropriate words=3, Confused, disoriented=4, Oriented, converses normally=5

    Makes no movements=1, Extension to painful stimuli (decerebrate response)=2, Abnormal flexion to painful stimuli (decorticate response)=3, Flexion / Withdrawal to painful stimuli=4, Localizes painful stimuli=5, Obeys commands=6
  37. When does the diaphram contract?
    When air moves into the lungs
  38. The anatomical structure where the trachea splits into two bronchi is called?
  39. What is the metabolic activity necessary to maintain cellular functions at rest called? (provides a constant supply of heat)
    basal metabolism 
  40. Conduction
    transfer of heat to objects in direct contact with the body. The transfer of heat is 5 times greater with wet clothing and 25 times greater submerged in water
  41. What does most heat loss occur by?
    • Radiation=60%
    • Evaporation=22%
    • Conduction=15% 
  42. What happens in the blood when heat must be lost?
    Vasodilation occurs to allow more blood to be in contact with the skin so that heat can be lost. 
  43. What happens in the blood when heat must be conservered?
    Skin vessels undergo vasoconstriction to reduce heat loss to the enviroment
  44. Who can become hypothermic at room temp?
    Patients with compromised ability to generate heat or prevent heat loss, such as the young infants, elderly persons, or intoxicated patients
  45. If a patient can be transported to a hospitl in less than 2 hours with a cold emergency what is the treatment?
    Transport, protecting futher heat loss, protecting the injured parts.
  46. What are some drugs that suppress or inhibit the shivering response?
    Phenothiazines, barbiturates, and alcohol.
  47. When does shivering usually stop?
    When the body temperture dips below 87.8F or 31C. 
  48. When does amnesia and slurred speach may appear during a cold emerengcy?
    92F, 34C.
  49. How fast does metabolism decrease for every centigrade degress the body's temperture drops?
  50. How fast can someone die from an acute immeresion in icy water?
    15 minutes. Rarely someone can survive for more than an hour at tempertures of 60F or 15.5 C
  51. What are some signs and symptoms of hypothermia?
    the abdomen is cold to the touch. Decreased levels of consciousness, decreased motor ability, depressed vital signs. 
  52. Mild Hypothermia
    • 89.6F-95F or 32C-35C
    • cool, flushed, or pale skin. shivering. diffculty in speech and movement and amnesia. Vitals may be normal  
  53. Moderate hypothermia
    • 80.6F-89.6F or 27C-32C
    • Patient becomes stupor. Shivering stops and is replaced with muscular rigidity and gradual loss of voluntary motion. Cardic output drops, pulse and respirations become depressed, and pupils dilate. Skin is pale or cyanotic. Pulse becomes irregular from the development of dysrhythmias. 
  54. What temperture does the body have to hit when ventricular fibrillation may develop?
    82.4F or 28C
  55. Severe Hypothermia
    • <80.6F or <27C
    • Cerebral blood flow is one third of normal, and patient is unresponsive to pain. Cardiac output is greatly depressed, and significant hypotension is noted. Cardiac arrest is likley 
  56. If needed to give respirations to a hypothermic patient what should you avoid?
    hyperventation because it can cause rapid changes in the acidity of the blood and may lead to dyshythmias. 
  57. How long to asses pulse in a hypothermic patient?
    30-45 seconds before starting CPR. 
  58. What if shock is advised in a hypothermic patient?
    Provide one shock, Then continue CPR. 
  59. What is the temperture where you should not give shocks to a paitent in hypothermia?
    86F or 30C
  60. Frostnip
    Appear as sudden blaching of the area. Loss of feeling. The area can be warmed by applying firm pressure. On rewarming the skin may be red and a tingling sensation may be noted
  61. Superficial Frostbite
    Freezing of water within the upper layers of the skin. Appears white and waxy. Firm to the touch. After thawing the skin may appear flushed or mottled with alternating patchy red-purple and blanched areas. 
  62. Deep Frostbite
    Extends throughout the dermis, subcantenous tissue, tendons and possbility bone. Skin becomes white, feels frozen, and resists depression. 
  63. Mangement of Frostbite
    Cover the injured part, protect from futher cold. Protect area from moisture and remove wet clothes and jewerly. Do not break any blisters. If hands or feet are involved sperate the fingers and toes with small, folded dressings. 
  64. What does trenchfoot present with
    Cold, swollen, pale, blue with diminished pulses and sensation. Then the foot appears red, hot and dry from increased circulation. Pulses may be bounding. Extreme pain. 
  65. Orthostatic hypotension
    Fall in blood pressure when the supine patient stands up
  66. What to do for a poinsous bite or sting
    a constricting band should be placed above the bite. Remove the stinger. Place ice pack over the bite or sting.
  67. What can the brown recluse spider cause?
    necrosis or death of a portion of tissue
  68. High altitude cerebral edema (HACE)
    Swelling of the brain following rapid ascent to altitude. Can mimic a stroke. Headache, alteration in vision and hearing. Alteration in level of consciousness. Weakness or paralysis which tend to be bilateral. Nausea and vomiting may occur
  69. High altitude pulmonary edema (HAPE)
    Fluid is pushed rapidly into the alveolar spaces as a person ascends rapidly into the sky. Person becomes rapidly hypoxic. productive cough and cyanosis. Bilateral rales and rhonchi or coarse crackles. Altered level of consciousness. 
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